therapists who do not maintain awareness of countertransference responses including anger and resentment toward the client, lack of insight into personal vulnerabilities, excessive need for client approval, emotional immaturity, poor social judgment, compulsive exploitation of others due to narcissistic traits, and/ or substance abuse. He also notes that many cases involve the “wounded healer”; the clinician is struggling with their own divorce or relationship problems or the death of a close person, they are emotionally needy, or they have exceptionally high dependency needs. The California Department of Consumer Affairs (2019) has published a detailed booklet addressing sexual misconduct Attraction to Clients Jacob and colleagues (2022) note that very limited time is spent in training programs discussing the issue of therapist attraction to their client or teaching strategies to manage it. They offer suggestions for managing these feelings: 1. Do not act on the attraction. This is a clear abuse of power and unethical and likely illegal. 2. Do not disclose the feelings to the client. This places an unnecessary burden on the client and is being done for the therapist’s benefit and not the client’s. 3. Do not dismiss, minimize, or ignore the feelings, but also do not obsessively focus on them. Careful scrutiny of thoughts and feelings in a mindful way is recommended. Sexual Harassment Sexual harassment of a client by the therapist is also specifically addressed in professional codes of ethics and is a prohibited behavior: ● APA (2017) prohibits sexual harassment, defined as sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, is offensive and unwelcome, and is sufficiently intense to be considered abusive in the context (Standard 3.02). ● NASW (2021) states that social workers should not sexually harass clients. This includes sexual advances, sexual solicitation, requests for sexual favors and any other verbal, written, electronic, or physical contact of a sexual nature (Standard 1.11).
by therapists. Therapist warning signs suggesting misconduct include: ● Telling sexual jokes or stories ● Sending obscene images or messages to clients ● Unwanted physical contact ● Excessive out-of-session communications ● Inviting a client to lunch, dinner, or other social events ● Confiding in a client about the therapist’s personal love life ● Telling the client that they are special to the therapist ● Relying on the client for personal or emotional support ● Suggesting or supporting the client’s isolation from support systems or fostering dependency on the therapist ● Providing alcohol or drugs during therapy sessions 4. Consult with a supervisor or colleague. Do not let feelings of embarrassment, guilt, or shame prevent consultation for the purpose of processing, reflecting, and resolving the situation. Self-Assessment Quiz Question #5 A sexual relationship with a current client: a. Is not always a boundary violation ● ACA (2014) states that counselors do not engage in or condone sexual harassment (Standard C.6.a). ● AAMFT (2015) states that therapists do not engage in sexual or other forms of harassment of clients (Standard 3.7). Clinical Consideration : Verbal, nonverbal, or physical contact with a current client that is sexual in nature is a firm boundary violation that can result in serious personal, professional, and legal consequences to the clinician. ● NBCC (2023) states that counselors do not engage in any type of harassing behavior toward clients, defined as any verbal, nonverbal, electronic, or physical act that is unwelcome or of a severity that it would be perceived as harassment (Standard 25). b. May be legal in some states c. Has clear potential for harm d. Is not considered exploitative
BOUNDARY CROSSINGS AND ETHICAL DECISION-MAKING
Whenever a boundary crossing is considered, the clinician must evaluate whether it is ethical and appropriate. Clinicians tend to use a variety of methods to make these decisions. Professional codes of conduct provide guidelines for behavior based on professional values, but they often are aspirational and do not address the specific situation being faced by the provider. Decisions in day-to-day practice are often not clear cut and have a level of ambiguity. Grace and colleagues (2020) appropriately note that, leaving aside serious boundary violations, ethical dilemmas like decisions about boundary crossings are part of the day-to-day practice of clinicians. Although knowledge of one’s professional code of conduct is essential, it is often not sufficient when considering a boundary crossing or when faced with an ethical dilemma. At these times the clinician needs a framework for determining the most ethical course of action. Ethical decision-making models are designed to guide the clinician in a systematic way to determine an acceptable and defensible decision or course of action. Several professional codes of ethics require the clinician to use a formal decision-making model and to document that in the client’s chart. Other codes do not specifically require use of a formal model, but all direct the clinician to evaluate ethical situations critically. ● ACA (2014) states that when faced with ethical dilemmas, such as a potential boundary crossing, counselors use and document an ethical decision-making model that may include consultation, consideration of relevant ethical
standards and laws, generation of potential course of action, deliberation of risks and benefits, and selection of an objective decision (1.1.b). The counselor is expected to use a credible model of decision making that can bear public scrutiny of its application. ● NBCC (2023) states that when confronted by ethical dilemmas, the counselor shall engage in an ethical decision- making process and consult available resources. ● APA (2017) does not specifically address the use of a decision-making model. However, the principles are in the process of being updated through the APA Ethics Code Task Force, and they will include a formal decision-making tree. Roberts and Termuehlen (2021) identified six core skills that are used by mental health professionals, which affect their ability to recognize and manage ethical issues: 1. The ability to identify ethical issues as they arise. This is intuitive for some, a feeling or sense that something is not right, and for others it is a more logical analysis. 2. The ability to understand how one’s own values and beliefs impact their care of patients. This includes implicit bias, the understanding of how one’s attitudes and social stereotypes affect access to health care and equity in quality. Implicit bias can adversely affect quality, safety outcomes, and health system policies.
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Book Code: PYFL4024
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